Healthcare Provider Details

I. General information

NPI: 1750800520
Provider Name (Legal Business Name): RIBAUT MEDICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 RIBAUT RD
BEAUFORT SC
29902-5437
US

IV. Provider business mailing address

PO BOX 2329
BEAUFORT SC
29901-2329
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-2001
  • Fax:
Mailing address:
  • Phone: 843-524-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD22623
License Number StateSC

VIII. Authorized Official

Name: DR. SAMUEL CLARK TRASK
Title or Position: OWNER
Credential: MD
Phone: 843-524-2001